HealthCare Roundtable e-News – October 17, 2023

Top News

One-Year Update on Lowering Prescription Drug Costs in the U.S

In the one-year update on President Biden’s Executive Order 14087, which aims to lower prescription drug costs for Americans, the Secretary of Health and Human Services outlined three selected models to improve drug affordability and access for Medicare and Medicaid beneficiaries. These models are the Medicare $2 Drug List Model, the Cell and Gene Therapy Access Model, and the Accelerating Clinical Evidence Model.

  1. The Medicare $2 Drug List Model: This model would allow Part D plan sponsors to offer a low, fixed copayment (up to $2 per month supply) for a standard Medicare-defined list of generic drugs targeting common chronic conditions. It seeks to provide predictable copayments, encouraging patient adherence to medication.
  2. The Cell and Gene Therapy Access Model: This multi-state approach aims to facilitate outcomes-based agreements (OBAs) in Medicaid for cell and gene therapies. It seeks to address the high upfront costs of these therapies and increase access to novel treatments, particularly for historically underserved populations.
  3. The Accelerating Clinical Evidence Model: This model proposes Medicare Part B payment adjustments to providers for drugs approved through the Accelerated Approval Pathway (AAP). It aims to encourage drug manufacturers to complete confirmatory trials promptly to ensure the effectiveness of these drugs.

The Innovation Center is actively developing these models, considering factors like feasibility, effectiveness, and the impact of the Inflation Reduction Act on these models. The goal is to improve drug affordability, increase access, and reduce out-of-pocket costs for beneficiaries. These initiatives align with the Biden-Harris Administration’s commitment to addressing drug affordability and accessibility, and further engagement with stakeholders is encouraged to ensure the models meet beneficiaries’ needs and encourage participation.

 

CMS Reveals 2024 Medicare Part A, Part B, and Part D Premiums, Deductibles, and Adjustments

On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the 2024 premiums, deductibles, and income-related monthly adjustment amounts for Medicare Part A, Part B, and Part D programs. They also highlighted efforts to improve healthcare access and affordability through Medicare Savings Programs (MSPs) and the Part D low-income subsidy (LIS). For Medicare Part B, the standard monthly premium for 2024 will be $174.70, an increase of $9.80 from 2023, with an annual deductible of $240, up by $14 from 2023. These adjustments are due to projected increases in healthcare spending and changes related to the 340B-acquired drug payment policy. Medicare Part A covers inpatient hospital services, and the deductible for 2024 will be $1,632, an increase of $32 from 2023. There are also coinsurance amounts for extended hospital stays and skilled nursing facilities. Part D premiums are income-based, and the income-related monthly adjustment amounts affect about 8 percent of beneficiaries. Premiums for 2024 vary based on income levels. Overall, these changes aim to provide transparency and assistance for Medicare beneficiaries in understanding their costs and options for 2024.

Regulatory Action

The U.S. Food and Drug Administration (FDA) announced the creation of a new Digital Health Advisory Committee. The goal of the committee is to support the agency in its exploration into the scientific and technical issues related to digital health technologies (DHTs). These DHTs include artificial intelligence (AI), machine learning (ML), augmented reality, virtual reality, digital therapeutics and remote patient monitoring software. The committee will consist of individuals that possess technical and expertise from a variety of disciplines. There will be nine voting members, including a chairman, with temporary members being added for specific meetings depending on the topic. The FDA is taking nominations for representatives to serve as a voting or non-voting member of the Digital Health Advisory Committee. Nominations can be submitted here.

Research

  • JAMA Network Open published an article that addresses the question: “Are there differences in health professionals’ engagement with hospitalized patients’ electronic health records (EHRs) with respect to race and ethnicity?” Researchers conducted a cross-sectional study at Vanderbilt University Medical Center and Northwestern Medicine between 2018 and 2020 to analyze the engagement of health professionals with the EHRs of 243,216 adult patients. It was discovered that, compared to the EHRs of White patients, the EHRs of minority populations, specifically Black and Hispanic patient groups, had less engagement from health professionals. This finding is significant because there is evidence suggesting that a higher level of EHRs effort is associated with better patient outcomes. Moreover, a lack of engagement with EHRs could lead to uninformed clinical decision-making and biased results in clinical research, public health surveillance, and quality assurance. The article highlights lack of access, communication barriers, underrepresentation in clinical research, and racial discrimination as potential causes for the disparities in health professionals’ engagement with EHRs.
  • The National Health Spending Explore, an interactive tool developed by Kaiser Family Foundation using data from the National Health Expenditure Accounts of the Centers for Medicare and Medicaid Services (CMS) released new data regarding projected spending. Generally, health spending is expected to rebound in the coming years. At a growth of 2.6% annual rate in 2021 due to pandemic management, CMS expects growth to 4.8% annual rate per capita in 2022 to 2031 as healthcare utilization returns to pre-pandemic levels and price inflations as the 2024 Affordable Care Act (ACA)-regulated health plans show a median proposed premium increase of 6%. Though per enrollee Medicaid spending is expected to grow to a record 7.4% per capita in 2024, overall Medicaid spending is expected to decrease by $834 billion in 2023. In private insurance enrollees, spending is also expected to growth at 6.8% annually in 2023 and 2024. Furthermore, aggregate hospital spending is expected to increase by 9.3% annually and physician and clinical services are expected to increase at an average of 5.7% annually. Out-of-pocket spending per capita on hospital and physician services are also expected to continue increasing to 2031 with a growth of 4.9% per year in hospital services ($148 per capita by 2031) and a growth of 3.9% per year in physician and clinical services ($284 per capita by 2031). Despite higher utilization of healthcare services, prescription drug spending growth is expected to fall from 7.8% in 2021 to 5.1% in 2022, falling below spending in hospital and physician services.

Registration Open for 2023 Annual Conference

The Public Sector HealthCare Roundtable 2023 Annual Conference Moves to Washington, DC

The conference features a new location, a revised format, and a great agenda!

Wednesday, Nov. 1 to Friday, Nov. 3, 2023

The Roundtable’s highly-regarded annual conference provides members and guests a unique opportunity to hear presentations by high level government officials and key experts – from Congress and the Administration, academics, benefit consultants, plan administrators, advocates and industry leaders in an intimate dialogue-oriented setting.

After years of successful conferences in Old Town Alexandria, we have outgrown our space at the Alexandrian Hotel. This year we will hold our conference at the historic Mayflower Hotel in Washington, DC. The new location will undoubtedly improve the overall experience for all of our attendees.

In recent years, many of our attendees have urged us to schedule more free time in the conference agenda for networking. Since we understand the importance of this networking time, we have revised this year’s agenda to incorporate longer breaks and more time before evening receptions.

This year, the conference will begin at Noon on Wednesday, November 1st and will conclude at Noon on Friday, November 3rd. By adding time on Wednesday, we have been able to add critical content, lengthen our breaks, and add free time prior to any evening activities.

Although we certainly believe the best way to experience our conference is in-person, this year’s conference will once again feature a virtual option. Any health plan that registers at least one individual to join us in Washington, will be eligible to register online attendees.

Register Today